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The addition of droperidol or clonidine to epidural tramadol shortens onset time and increases duration of postoperative analgesia

[L’addition de dropéridol ou de clonidine à l’administration péridurale de tramadol raccourcit le délai d’installation et prolonge la durée de l’analgésie postopératoire]

From the Department of Anesthesiology Pamukkale University Faculty of Medicine Denizli Turkey.

Address correspondence to: Dr. Ercan Gürses, Atakent Mahallesi, Esnaf Sitesi Zambak Sokak, No: 8, Yenisehir, 20045 Denizli, Turkey. Phone: +90-258-241 00 34/113; +90-258-373 58 38; Fax: +90-258-373 13 42; E-mail: elgurses{at}pamukkale.edu.tr

Purpose: To compare tramadol alone and the combinations of either tramadol-clonidine or tramadol-droperidol with regard to analgesic and adverse effects.

Methods: After Ethic’s Committee approval and patient informed consent were obtained, epidural catheters were inserted preoperatively at the L_3–4 interspace in 90 ASA physical status I–II adult patients undergoing lower abdominal surgery. Anesthesia was standardized. Patients were randomly assigned to one of three groups. Group I (T) patients received tramadol 75 mg, Group II (TD) patients received tramadol 75 mg plus droperidol 2.5 mg, and Group III (TC) patients received tramadol 75 mg plus clonidine 150 µg in a total volume of 10 mL administered as a single epidural injection in the postanesthesia care unit. The onset time of analgesia and duration of analgesia, visual analogue pain scores, sedation, nausea scores, vital signs and side effects were recorded.

Results: Duration of analgesia was similar in both the TD and TC groups, and significantly longer than in the T group (P < 0.001). Group TC patients displayed a significant increase in sedation scores and decrease in blood pressure and heart rate when compared with other groups (P < 0.001). No adverse effects were observed in Group TD, while nausea scores were high in both the T and TC groups (P < 0.001). Pain score, respiration rate, and SpO₂ values were similar in all study groups.

Conclusion: We conclude that epidural tramadol in combination with droperidol or clonidine prolongs the duration of analgesia; however, droperidol appears to be a better alternative when adverse effects and antiemetic properties are taken into consideration.

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